Uso da laserterapia de baixa intensidade na prevenção e tratamento da mucosite oral induzida por tratamentos antineoplásicos / Use of low-intensity lasertherapy in the prevention and treatment of oral mucositis induced by antineoplastic treatments

Sabe-se que para o combate de células cancerígenas, é imprescindível a submissão de pacientes oncológicos a tratamentos antineoplásicos, sessões de quimioterapia e radioterapia são as terapêuticas mais utilizadas em pacientes neoplásicos, sendo capazes de originar inúmeras reações adversas, como a mucosite oral, que é considerada um dos principais efeitos adversos do tratamento com quimioterapia e radioterapia. A laserterapia vem sendo considerada um grande aliado na prevenção e tratamento da mucosite, visto que de forma preventiva retarda o aparecimento desta condição, e de forma terapêutica proporciona alívio da dor, além de reduzir a gravidade da mucosite oral. Dessa forma, a presente revisão de literatura teve por objetivo denotar os benefícios da laserterapia de baixa intensidade na prevenção e tratamento da mucosite oral induzida por tratamentos antineoplásicos. Para a confecção deste trabalho, foram pesquisados artigos científicos publicados entre 2012 e 2022, nas bases de dados PubMed, Portal BVS, Scielo e google acadêmico, nos idiomas inglês e português. Como resultado foram encontrados 59 trabalhos, onde após leitura dos títulos e resumos, e do tipo de estudo, foram excluídos 32 artigos. Sendo 27 selecionados para leitura integral do texto, onde dentre eles somente 19 se encaixaram nos critérios de inclusão e foram utilizados neste trabalho. Portanto, conclui-se que a literatura mostra que embora haja bastante discussão, a maior parte dos estudos mostram evidências que a laserterapia de baixa intensidade possui muitos benefícios na prevenção e no tratamento da mucosite oral devido sua capacidade moduladora nos eventos metabólicos por meio de processos fotofísicos e bioquímicos(AU)

It is known that in order to fight cancer cells, it is essential to submit cancer patients to antineoplastic treatments, chemotherapy and radiotherapy sessions are the most used therapies in cancer patients, being capable of causing numerous adverse reactions, such as oral mucositis, which is considered one of the main adverse effects of chemotherapy and radiotherapy treatment. Laser therapy has been considered a great ally in the prevention and treatment of mucositis, since in a preventive way it delays the onset of this condition, and in a therapeutic way it provides pain relief, in addition to reducing the severity of oral mucositis. Thus, the present literature review aims to denote the benefits of low-level laser therapy in the prevention and treatment of oral mucositis induced by antineoplastic treatments. For the preparation of this work, scientific articles published between 2012 and 2022 were searched in PubMed, Portal BVS, Scielo and academic google databases, in English and Portuguese. As a result, 59 studies were found, where after reading the titles and abstracts, and the type of study, 32 articles were excluded. 27 were selected for full text reading, among which only 19 met the inclusion criteria and were used in this work. Therefore, it is concluded that the literature shows that, although there is a lot of discussion, most studies show evidence that low-level laser therapy has many benefits in the prevention and treatment of oral mucositis due to its modulating capacity in metabolic events through processes photophysical and biochemical(AU)

Necesidad de actualización de los conocimientos sobre laserterapia en profesionales de estomatología / Necessity of updating knowledge on laser therapy in stomatology professionals

Introducción: El conocimiento sobre laserterapia es necesario en los profesionales de las especialidades médicas y estomatológicas, a fin de emplearla apropiadamente en los pacientes. Objetivo: Identificar la necesidad de conocimientos sobre laserterapia en profesionales de estomatología. Métodos: Se realizó un estudio descriptivo y transversal, desde marzo de 2020 hasta abril de 2021, en 60 profesionales del Servicio de Estomatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, en quienes se aplicó una encuesta cuyas respuestas fueron catalogadas en adecuadas e inadecuadas. Asimismo, se utilizaron métodos empíricos y estadísticos para el análisis de los resultados. Resultados: La mayoría de los encuestados habían obtenido los conocimientos en la formación de pregrado; asimismo, se obtuvo un porcentaje superior de respuestas adecuadas en cuanto a las propiedades de la terapia con láser, las precauciones para su aplicación y las contraindicaciones relacionadas con el tratamiento quirúrgico. Al analizar el conocimiento según categoría profesional, se pudo comprobar que los especialistas poseían una noción más adecuada acerca del tema que el resto de los participantes en la investigación. Conclusiones: Los profesionales mostraron conocimientos insuficientes para aplicar la laserterapia; por ende, se requiere trazar una estrategia de superación que posibilite capacitarles en tan importante tema.

Introduction: Knowledge on lasertherapy is necessary in professionals of medical and stomatological specialities, so as to use them properly in patients. Objective: To identify the scarce knowledge on lasertherapy in stomatology professionals. Methods: A descriptive and crossed-sectional study was carried out from March 2020 to April, 2021, in 60 professionals in the stomatological service from Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, in whom a survey was applied and their answers were classified as adequate or inadequate. Likewise, empiric and statistics methods were used for the analysis of results. Results: Most of the surveyed professionals had acquired knowlegde during their pre-degree training, in the same way, a higher percentage of adequate answers was obtained regarding the properties of therapy with laser, meassures for its use, and contraindications related to surgical treatment. When analizing knowledge according to professional categories, it could be proven that specialists had a more adequate notion on the topic than the rest of participants in the study. Conclusions: Professional showed scarce knowledge on to use lasertherapy; so, it is required to elaborate a training estrategy to prepare them in such an important topic.

Terapias físicas en pacientes con trastornos de la articulación temporomandibular / Physical therapies in patients with temporomandibular joint disorders

RESUMEN Introducción: Se denomina trastorno temporomandibular al conjunto de condiciones musculoesqueléticas que afectan la articulación temporomandibular, los músculos de la masticación y las estructuras anatómicas adyacentes. Objetivo: Evaluar la efectividad de las terapias físicas en pacientes con trastornos de la articulación temporomandibular. Métodos: Se efectuó una intervención terapéutica en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde junio de 2016 hasta febrero de 2020. La muestra quedó conformada por 264 pacientes distribuidos en 4 grupos con 66 integrantes cada uno, a quienes se les aplicaron diferentes terapias físicas, tales como ultrasonido, laserterapia, magnetoterapia y técnica de estimulación eléctrica transcutánea, respectivamente. Se analizaron las siguientes variables: edad, grado de trastorno de la articulación temporomandibular y efectividad terapéutica. Se empleó el porcentaje como medida de resumen y el estadígrafo de Ji al cuadrado con un nivel de significación de 0,05. Resultados: Predominó el sexo femenino en todas las terapias aplicadas con más de 75,0 % y el grupo etario de 40 - 49 años. Al finalizar el tratamiento se observó que en los grupos donde se empleó ultrasonido, láser y magneto, la respuesta fue efectiva en más de 90,0 % de los pacientes, con primacía del primero (96,6 %); sin embargo, en el grupo donde se utilizó la técnica de estimulación eléctrica transcutánea solo se logró en 89,4 % de los afectados. Conclusiones: La ultrasonoterapia fue más efectiva en pacientes con trastornos de la articulación temporomandibular.

ABSTRACT Introduction: A temporomandibular disorder is a group of musculoskeletal conditions that affect the temporomandibular joint, the mastication muscles and the adjacent anatomical structures. Objective: To evaluate the effectiveness of the physical therapies in patients with temporomandibular joint disorders. Methods: A therapeutic intervention was carried out in Mártires del Moncada Teaching Provincial Stomatological Clinic from Santiago de Cuba, from June, 2016 to February, 2020. The sample was formed by 264 patients distributed in 4 groups with 66 members each one, to whom different physical therapies were applied, such as ultrasound, laser therapy, magnetotherapy and technique of transcutaneous electric stimulation, respectively. The following variables were analyzed: age, grade of dysfunction of the temporomandibular joint and therapeutic effectiveness. The percentage as summary measure and the chi-squared test were used with a significance level of 0.05. Results: There was a prevalence of the female sex in all the therapies applied with more than 75.0 % and the 40 - 49 age group. When concluding the treatment it was observed that in the groups where ultrasound, laser and magneto was used, the response was effective in more than 90.0 % of the patients, with primacy of the first one (96.6 %); however, in the group where the technique of transcutaneous electric stimulation was used it was just achieved in 89.4 % of the affected patients. Conclusions: The ultrasonotherapy was more effective in patients with temporomandibular joint disorders.

Láser de baja potencia como coadyuvante en tratamiento endodóntico de pieza con reabsorción interna y lesión apical: reporte de un caso / Use of low level laser as an adjunct in endodontic treatment of teeth with internal resorption and apical lesión

La reabsorción radicular interna es infrecuente en dentición permanente, la mayoría de los casos se observan en dientes anteriores, su etiología no está del todo clara, es por esto que el tratamiento para este tipo de lesiones es la endodoncia. Se presenta el caso de una paciente sexo femenino, 38 años de edad, sin antecedes médicos relevantes, derivada para evaluación de diente 2.2 con mal pronóstico. El diagnóstico es de absceso apical agudo, pieza con reabsorción interna y lesión apical. Se realiza endodoncia con cementos biocerámicos y aplicación de láser terapéutico de 808 nm de longitud de onda, con parámetros específicos para acelerar la reparación del tejido óseo. La terapia de fotobiomodulación con láser de baja potencia parece ser útil como coadyuvante en el proceso de reparación ósea en piezas con lesión apical y reabsorción interna tratadas endodónticamente.

Internal root resorption is infrequent in permanent dentition, most cases are observed in anterior teeth, its etiology is not entirely clear, which is why the treatment for this type of lesion is endodontics.We present the case of a 38-year-old female patient, without relevant medical history, referred for evaluation of tooth 2.2 with a poor prognosis. Diagnosis Acute apical abscess, tooth with internal resorption and apical lesion. Endodontics are performed with bioceramic cements and the application of a 808 nm wavelength therapeutic laser, with specific parameters to accelerate bone tissue repair.Low-level laser photobiomodulation therapy appears to be useful as an adjunct in the bone repair process in endodontically treated teeth with apical lesion and internal resorption.

The effect comparision of femtosecond laser-assisted phacoemusification and microincision phacoemusification on ocular surface / 中华实验眼科杂志

Objective@#To compare the effects of femtosecond laser-assisted phacoemusification and microincision phacoemusification on ocular surface.@*Methods@#A nonrandomized comparative cohort study was designed.The study recruited 116 eyes of 116 patients with age-related cataract in Hankou Aier Eye Hospital from January to March 2018.Consecutive patients were divided into femtosecond laser-assisted phacoemulsification group (femtosecond laser group for short) (55 eyes) and microincision phacoemulsification group (microincision group for short) (61 eyes). The ocular surface disease index(OSDI), break-up time of tear film (BUT), corneal flurescein staining, Schirmer Ⅰ test (SⅠt) and goblet cell density were sequentially evaluated preoperatively and postoperatively at 1 week and 1 month.This study followed the Declaration of Helsinki.Written informed consent was obtained from each subject prior to entering study cohort.This study protocol was approved by Ethic Committee of Hankou Aier Eye Hospital (No.2017IRB01).@*Results@#At 1 day after surgery, the best corrected distance visual acuity (BCDVA) (LogMAR visual acuity) was 0.14(0.10, 0.24) and 0.20 (0.17, 0.27), respectively in the femtosecond laser group and the microincision group.BCDVA in the femtosecond laser group was better than that in the microincision group, with a significant difference between them(U=-3.140, P=0.002). Compared with the microincision group, the operation time was longer, the phaco time was shorter, the cumulative dissipated energy was lower, and the balanced salt solution perfusion volume was less in the femtosecond laser group, with significant differences between them (all at P<0.001). Compared with the pre-operation, the mean OSDI socres, BUT and goblet cell density were significantly decreased, and the fluorescein staining scores were significantly increased at 7 days and 30 days after surgery in the femtosecond laser group and the microincision group, with significant differences between them (all at P<0.05). The SⅠt value fluctuations in the two groups were small at different time points before and after operation, and the overall comparative differences between the two groups and different time points had no statistical significances (Fgroup=0.510, P=0.477; Ftime=0.741, P=0.479).@*Conclusions@#Compared with microincision phacoemusification, patients who had femtosecond laser-assisted phacoemusification have more severe ocular surface staining, shorter tear film time and more reduction of goblet cell count at the early stage.

Comparison of lens anterior capsular changes between femtosecond laser-assisted phacoemulsification and conventional phacoemulsification for cataract patients with diabetes / 中华实验眼科杂志

Objective@#To compare the anterior capsule opacification and contraction of lens following femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract patients with diabetes.@*Methods@#A non-randomized control study was carried out.Eighty-five eyes of 85 cataract patients with diabetes were included from March 2015 to August 2016 in Xiamen Eye Center.The patients were divided into 2 groups based on the different surgeries.Forty-three eyes of 43 patients in the femtosecond laser group received femtosecond laser-assisted phacoemulsification and completed the 5.3 mm capsulorhexis using the Alcon LenSx femtosecond laser platform.Forty-two eyes of 42 patients in the conventional surgery group underwent conventional phacoemulsification group and performed 5.3 mm continuous circular capsulorhexis under the guidance of Alcon VERION.Anterior capsule opacification (ACO) was graded according to Werner's method.The area of anterior capsular opening was calculated by using Image Pro Plus 6 software.The number of eyes in different grades of ACO and anterior capsule opening area between two groups were compared at 1 month, 3 months and 6 months after operation.@*Results@#Initial anterior capsular opening area was not significantly different between the femtosecond laser group and the conventional phacoemulsification group (t=0.003, P=0.958). The anterior capsule opening area in the two groups among different time-points after operations was significantly different (Fgroup=73.602, P<0.001; Ftime=378.895, P<0.001), and anterior capsule opening areas were smaller in the conventional phacoemulsification group than those in the femtosecond laser group at various time points after operation (all at P<0.001). At 1 month after suigery, grade Ⅰ of the ACO was found in 29 eyes (67.4%) in the femtosecond laser group and 26 eyes (61.9%) in the conventional phacoemulsification group, and there was no significant difference between two groups (P=0.133). At 3 months after surgery, the incidence rate of grade Ⅱ of ACO was 11.6% (5/43) in the femtosecond laser group, which was lower than than that in the conventional phacoemulsification group(66.7%, 28/42), showing a significant difference between them (P<0.001). At the 6th month after operation, the incidence rate of grade Ⅲ of ACO in the femtosecond laser group was 14.0%(6/43), which was lower than that in the conventional phacoemulsification group(73.8%, 31/42), with a significant difference between them (P<0.001).@*Conclusions@#Femtosecond laser-assisted cataract surgery for cataract is a good choose patients with diabetes mellitus because of reducing the occurrence of ACO and the contraction of anterior capsule.

Comparison of lens anterior capsular changes between femtosecond laser-assisted phacoemulsification and conventional phacoemulsification for cataract patients with diabetes / 中华实验眼科杂志

Objective To compare the anterior capsule opacification and contraction of lens following femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract patients with diabetes. Methods A non-randomized control study was carried out. Eighty-five eyes of 85 cataract patients with diabetes were included from March 2015 to August 2016 in Xiamen Eye Center. The patients were divided into 2 groups based on the different surgeries. Forty-three eyes of 43 patients in the femtosecond laser group received femtosecond laser-assisted phacoemulsification and completed the 5. 3 mm capsulorhexis using the Alcon LenSx femtosecond laser platform. Forty-two eyes of 42 patients in the conventional surgery group underwent conventional phacoemulsification group and performed 5. 3 mm continuous circular capsulorhexis under the guidance of Alcon VERION. Anterior capsule opacification (ACO) was graded according to Werner's method. The area of anterior capsular opening was calculated by using Image Pro Plus 6 software. The number of eyes in different grades of ACO and anterior capsule opening area between two groups were compared at 1 month,3 months and 6 months after operation. Results Initial anterior capsular opening area was not significantly different between the femtosecond laser group and the conventional phacoemulsification group (t=0. 003,P=0. 958). The anterior capsule opening area in the two groups among different time-points after operations was significantly different (Fgroup=73. 602, P<0. 001;Ftime=378. 895,P<0. 001),and anterior capsule opening areas were smaller in the conventional phacoemulsification group than those in the femtosecond laser group at various time points after operation ( all at P<0. 001 ) . At 1 month after suigery, grade Ⅰ of the ACO was found in 29 eyes ( 67. 4％) in the femtosecond laser group and 26 eyes ( 61. 9％) in the conventional phacoemulsification group,and there was no significant difference between two groups (P=0. 133). At 3 months after surgery,the incidence rate of gradeⅡof ACO was 11. 6％ (5/43) in the femtosecond laser group,which was lower than than that in the conventional phacoemulsification group ( 66. 7％, 28/42 ) , showing a significant difference between them (P<0. 001). At the 6th month after operation,the incidence rate of grade Ⅲ of ACO in the femtosecond laser group was 14. 0％(6/43),which was lower than that in the conventional phacoemulsification group (73. 8％,31/42),with a significant difference between them (P<0. 001). Conclusions Femtosecond laser-assisted cataract surgery for cataract is a good choose patients with diabetes mellitus because of reducing the occurrence of ACO and the contraction of anterior capsule.

Changes of tear film and corneal sensitivity after femtosecond laser-assisted cataract extraction surgery / 中华实验眼科杂志

Objective To compare the changes of tear film and corneal sensitivity between femtosecond laser-assisted cataract surgery and microincisional phacoemulsification surgery.Methods A prospective cohort study was performed.Fifty-three eyes of 53 patients with age-related cataract were included in Wuhan Aier Eye Hospital from March to July 2015.The patients were divided into femtosecond laser group and microincisional group.The 26 eyes in the femtosecond laser group received femtosecond laser-assisted cataract surgery,and 27 eyes in the microincisional group received 2.2 mm microincisional phacoemulsification surgery.The patients were followed-up for 3 months.The data of corneal sensitivity,Schirmer test values,non-invasive tear film break-up time (NIBUT) and subjective score for dryness were collected in 7 days,1 month and 3 months after surgery,and these results were compared between the two groups.This study was approved by Ethic Committee of Wuhan Aier Ophthalmology Hospital,and written informed consent was obtained from each patient prior to surgery.Results The operations were finished smoothly in all the eyes.In preoperative and 7 days,1 month,3 months after operation,the upper corneal sensitivity threshold and NIBUT between the two groups appeared a first reduction and a subsequent rise,the same phenomenon occurred in Schirmer test of the microincisional group and the subjective scores for dryness of the femtosecond laser group with statistically significant differences in the overall comparison (all at P＜ 0.05).No significant differences were seen in the central corneal sensitivity of the two groups and Schirmer test in the femtosecond laser group (all at P＞0.05).The dry eye scores increased gradually with the time expand after operation in the microincisional group,the difference was statistically significant (P＜0.05).In postoperative 3 months,these parameters were restored preoperative values.However,the dry eye scores in the microincisional group were still higher than that before operation,and the difference was statistically significant (P＜0.05).Conclusions Compared with the 2.2 mm microincisional phacoemulsification surgery,femtosecond laser-assisted cataract surgery brings less disturbance to lacrimal secretion,slight symptoms of dry eye and more comfortable sensation.

Low-level lasertherapy associated to occlusal splint to treat temporomandibular disorder: controlled clinical trial / Laserterapia de baixa intensidade associada ao uso de placa oclusal no tratamento de disfunção temporomandibular: estudo clínico controlado

ABSTRACT BACKROUND AND OBJECTIVES: Most widely used treatment modality for temporomandibular disorders is the occlusal splint. Low-level lasertherapy has been used as therapeutic agent, however as isolated treatment. So, this study aimed at evaluating the effect of the association of low-level lasertherapy and occlusal splint to treat temporomandibular disorders. METHODS: Participated in the study 25 selected patients according to the Research Diagnostic Criteria for Temporomandibular Disorders protocol. Control group (CG) was made up of 12 asymptomatic volunteers. Two groups were randomly formed: "splint-laser" (SLG), being treated with occlusal splint and associated low-level lasertherapy; "splint" (SG), treated with occlusal splint only. Jaw movements, pain at palpation and selfperception of signs and symptoms were investigated before and after treatment. RESULTS: There has been significant decrease in pain at palpation and reported pain according to self-perception of signs and symptoms for both groups, however more significant for SLG. There has been increased amplitude of jaw movements with significant difference after treatment for both groups. CONCLUSION: The association of low-level lasertherapy and occlusal splint to treat temporomandibular disorders has promoted more marked pain decrease as compared to occlusal splint alone. Placebo effect should not be discarded and should be tested in future studies.

RESUMO JUSTIFICATIVA E OBJETIVOS: A modalidade de tratamento mais empregada para disfunção temporomandibular é a placa oclusal. A laserterapia de baixa intensidade tem sido empregada como agente terapêutico, porém como tratamento isolado. Assim, o objetivo deste estudo foi analisar o efeito da associação da laserterapia de baixa intensidade ao uso da placa oclusal como tratamento para disfunção temporomandibular. MÉTODOS: Participaram do estudo 25 pacientes selecionados de acordo com o protocolo Research Diagnostic Criteria for Temporomandibular Disorders. O grupo controle (GC) foi formado por 12 voluntários assintomáticos. Dois grupos foram formados por sorteio: "placa-laser" (GPL), que recebeu tratamento com placa oclusal e laserterapia de baixa intensidade associada; "placa" (GP), que recebeu tratamento apenas com placa oclusal. Os movimentos mandibulares, a dor à palpação e autopercepção dos sinais e sintomas, foram investigados antes e após os tratamentos. RESULTADOS: Houve diminuição significativa da dor à palpação e da dor relatada de acordo com a autopercepção dos sinais e sintomas para ambos os grupos tratados, porém de forma mais acentuada para o GPL. Houve aumento da amplitude dos movimentos mandibulares com diferença significativa após os tratamentos para ambos os grupos. CONCLUSÃO: A associação da laserterapia de baixa intensidade ao tratamento da disfunção temporomandibular com placa oclusal promoveu diminuição mais acentuada do sintoma doloroso dolorosa quando comparado ao tratamento apenas com placa oclusal. O efeito placebo não deve ser descartado e deverá ser testado em estudos futuros

Effect of tear film stability on visual quality after femtosecond laser-assisted LASIK / 中华实验眼科杂志

Background The instability of tear film in dry eye often affects the visual quality after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).The prediction for visual quality following FS-LASIK was difficult in the past because of the limiting of examination method.OQAS-Ⅱ is a quantitative checking system of visual quality,which is helpful for the evaluation of the relationship between tear stability and visual quality following FS-LASIK.Objective This study was to investigate the predicting effects of the quality of tear film on visual quality after LASIK.Methods A prospective cohort study was performed.One hundred and twenty eyes of 120 myopic patients who wanted to receive FS-LASIK were enrolled in Nanjing First Hospital from August to December 2015 after informed consent.The objective scattering index (OSI) was 1.2 in the patients.The patients were divided into mild dry eye group (71 eyes) and non-dry eye group (49 eyes) based on the Expert Consensus on Clinical Diagnosis and Treatment of Dry Eye(2013).FS-LASIK was performed in the non-dry eye group,and 0.1％ sodium hyaluronate eye drops was topically administered for 1 month firstly and then the operation was carried out in the same way in the mild dry eye group.Slit lamp microscope,uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),spherical equivalent (SE) were examined,and the safety index and availability index were assessed.OQASTM Ⅱ analysis system was employed for the defection of Schirmer Ⅰ test (S Ⅰ t),breakup time of tear film (BUT),modulation transfer function cut-off frequency (MTF cut off) and mean OSI before and after surgery.Results The safety index was 1.05 ±0.11 and 1.03 ±0.09,and the availability index was 1.02±0.14 and 1.01 ± 0.12 in the non-dry eye group and mild dry eye group,respectively,showing significant differences between the two groups (t =0.391,0.147,both at P＞0.05).The BUT was evidently shortened 1 month and 3 months after surgery in comparison with before surgery in both non-dry eye group and mild dry eye group,and BUT in the mild dry eye group was shorter than that in the non-dry eye group in postoperative 3 months,with a significant differences between them (P＜0.05).The mean OSI was increased and MTF cutoff was reduced 1 month,3 months and 6 months after surgery in comparison with before surgery in both mild dry eye group and none-dry eye group,and mean OSI was higher and MTF cutoff was lower in the mild dry eye group than that in the non-dry eye group,with significant differences between them (all at P＜0.05).In postoperative 12 months,BUT,mean OSI and MTF cutoff were near normal in both groups.Conclusions FS-LASIK can improve objective visual quality,and preoperative tear film quality is associated with objective visual quality after FS-LASIK.The unstable tear film affects visual quality after FS-LASIK.OQASTM Ⅱ system can diagnose and monitor tear change of dry eyes,which is helpful for the screening of indicator of FS-LASIK and rational prediction of postoperative visual quality.

Paying attention to precision correcting surgery for cataract associated with corneal astigmatism / 中华实验眼科杂志

Corneal astigmatism in patients with cataract is very common,but it could not be accurately corrected during previous cataract surgery,which usually affects the visual quality seriously.The accurate measurement of corneal astigmatism power and meridian before surgery is key to the effective correction of astigmatism during the cataract surgery by either the determination of astigmatic keratotomies or the selection and implantation of toric intraocular lenses (IOL).The combination of IOL Master for sphere,the Pentacam for the total corneal refractive power and VERION Digital Marker for surgical orientation can provide promising refractive examination,treatment and good postoperative outcomes.Preexsisting astigmatism can be corrected during cataract surgery by modifying incision,performing arcuate keratotomy,or implanting a toric IOL.Femtosecond laser arcuate keratotomy combined with phacoemulsification is an effective,safe and precise method for the correction of low to moderate corneal astigmatism power,and it can improve visual acuity in cataract surgery candidates.Further work is required to establish corneal biomechanics numerical simulation and nomography protocol for cataract refractive surgery so as to improve the predictability and accuracy of femtosecond laser-assisted astigmatic keratotomy during refractive cataract surgery.

Choice of current approaches to the management of diabetic macular edema / 中华实验眼科杂志

Diabetic macular edema (DME) is the most common reason for visual impairment in diabetic eye diseases.DME is easy to relapse and the treatment outcome is beyond satisfied.Anti-vascular endothelial growth factor (anti-VEGF) therapy has been proposed to be a first-line or key treatment regimen in the management guideline for DME.However,in clinical practice,there still are many ambiguous and controversial views in the choice and implement of different managing paradigms,including the therapeutical goal,the assessment of treatment effectiveness,the explanation of the guidelines,the regimen of anti-VEGF therapy,the value evaluation of laser photocoagulation,the use of steroids and the management of recurrent DME.Recently,the researches of treating drugs for DME are developing and making a great progress,so eye doctors should track the research results,improve the therapeutical regimen,fully understand the advantages and disadvantages of different treating methods and standardize the treatment process in order to release the best treatment effects on DME.

Uso de modelos geométricos tridimensionais para melhorar a eficácia e segurança da lipoaspiração a laser: estudo prospectivo / Use of 3D geometrical models to improve efficacy and safety of Laser-assisted liposuction: a prospective study

INTRODUÇÃO: Baseada na informação disponível encontram-se dificuldades em estabelecer a dose apropriada de energia a laser para alcançar resultados previsíveis na lipoaspiração a laser. Este estudo avaliou a segurança e eficácia do laser diodo 980-nm com uso de fórmulas geométricas. Essas fórmulas permitem uma qualificação precisa do volume do tecido, e como consequência, uma estimativa da dose de laser necessária. MÉTODOS: Tratase de estudo prospectivo que avaliou consecutivamente 39 pacientes submetidos a lipoaspiração a laser diodo (LLD) 980-nm entre Novembro de 2011 e Novembro de 2013. Quatro padrões geométricos foram adotados para determinar o volume de gordura antes da aplicação do laser. A ultrassonografia foi utilizada para determinar a profundidade da gordura. Foram realizadas biópsias para estabelecer a reação imediata do tecido ao laser relativo à dose do laser. Os resultados estéticos e as complicações foram documentadas. Utilizou-se o coeficiente de correlação de Pearson para determinar a relação entre a energia aplicada e o volume do tecido. RESULTADOS: Um total de 163 áreas anatômicas foram tratadas com LLD 980-nm. A energia aplicada foi baseada no volume de cada área (R = 0,8786). Foi necessário dose de 8 a 14 J/cm3 para produzir dose de hemostase efetiva, e lipectomia mínima. Os resultados foram muito satisfatórios na maioria dos casos. A biópsia relevou lipectomia, balonamento, ruptura de membrana, e rompimento de banda de colágeno; essas mudanças variaram com a dose de radiação. As complicações foram somente edema e hematoma transitório. CONCLUSÃO: O uso de modelos geométricos tridimensionais melhoraram a segurança e eficácia da lipoaspiração a laser, pois permitiram determinar o volume do tecido.

INTRODUCTION: On the basis of the available information, it is difficult to establish the appropriate dose of laser energy with which to obtain predictable results in laser-assisted liposuction. The purpose of this study is to evaluate the safety and efficacy of a 980-nm diode laser by using geometrical formulas. These formulas allow a precise quantification of tissue volume and, as a result, an estimation of the required laser dose. METHODS: This prospective study was conducted to evaluate 39 consecutive patients who underwent 980-nm diode laser-assisted liposuction (LAL) between November 2011 and November 2013. Four geometric patterns were used to determine the volume of fat before laser application. Ultrasonography was used to determine fat depth. Biopsies were conducted to determine immediate laser tissue reaction relative to laser dose. The aesthetic results and complications were recorded. Pearson's correlation coefficient was used to determine the relationship between the applied energy and tissue volume. RESULTS: 163 anatomic regions were treated with 980-nm LAL. The applied energy was relative to the volume in each area (R = 0.8786). 8 to 14 J/cm3 was the dose needed to produce effective hemostasis and minimal lipolysis. The results were very satisfactory in most cases. Biopsy results revealed lipolysis, ballooning, membrane rupture, and collagen band breakage; these changes varied with the radiation dose. The only complications were edema and transient bruising. CONCLUSION: The use of 3D geometrical models improved safety and efficacy of laser-assisted liposuction by permitting accurate determination of the tissue volume.

Influence of laser therapy and muscle relaxant on the masseter muscle under occlusal wear: an ultrastructural study / Influencia de la terapia laser y relajante muscular en el músculo masetero bajo oclusión: un estudio ultraestructural

The aim of this study was to analyze the influence of low-intensity laser therapy and muscle relaxant in the characteristic ultra structural masseter muscle occlusal wear. Animals and Methods: 40 male Wistar rats were randomly divided into four groups: the control group (GI), occlusal wear (G-II), laser occlusal wear (G-III), and the muscle relaxant occlusal wear (G-IV). Under general anesthesia given intraperitoneally, animals in groups II, III and IV had unilateral amputation of upper and lower molar cusps to simulate an occlusal wear situation. The masseter muscle G-III received laser therapy (830nm, 4J/cm2, 40mW, f ~ 2mm) and the procedure was subsequently repeated every other day for 14/30 days. G-IV animals were treated with daily injection of dantrolene ® (2.5 mg / kg in 0.5 ml of H2O). From 24 hours after the elimination peak. The animals were euthanized with an overdose of anesthesia on days 14 and 30 after the removal of the cusps and the ipsilateral masseter muscle was excised and divided in two, one half was routinely processed for light microscopy and other for electron microscopy. There was no statistical difference between each experimental group and the control and between periods in each experimental group. However, the muscle fibers in the G-II showed the most pronounced changes. There is no causal relationship between muscles fibers injuries and occlusion and, despite signs of muscular tissue injury were more evident in the occlusal wear group. Results indicates a moderate action of laser therapy and muscle relaxants in skeletal muscle...

El objetivo del estudio fue analizar la influencia de la terapia láser de baja intensidad y del relajante muscular sobre las características ultraestructurales del músculo masetero en el desgaste oclusal. 40 ratas macho Wistar, se dividieron al azar en cuatro grupos: grupo de control (GI), desgaste oclusal (G-II), laserterapia desgaste oclusal (G-III), y relajante muscular desgaste oclusal (G-IV). Bajo anestesia general por vía intraperitoneal, los animales de los grupos II, III y IV sufrieron amputación unilateral de las cúspides de los molares superiores e inferiores para simular una situación de desgaste oclusal. El músculo masetero del G-III recibió la terapia con laser (830nm, 4J/cm2, 40mW, f ~ 2mm) después del procedimiento el cual se repitió durante 14/30 días. Los animales del G-IV fueron tratados con una inyección diaria de Dantroleno® (2,5 mg/Kg en 0,5 ml de H2O). Los animales fueron sacrificados con una sobredosis de anestesia general en los días 14 y 30. Después de la remoción de las cúspides el músculo masetero ipsilateral se extirpó y se dividió en dos, una mitad fue procesada para microscopía de luz y la otra para microscopía electrónica. No hubo diferencias estadísticamente significativas entre cada grupo experimental y el control, así como, entre los períodos en cada grupo experimental. Sin embargo, las fibras musculares en el G-II mostraron los cambios más pronunciados. En conclusión no existe relación causal entre las lesiones de las fibras musculares y la oclusión, a pesar que los signos de lesión de los tejidos musculares fue más evidente en el grupo con desgaste oclusal. Los resultados indican una acción moderada ejercida por la terapia láser y de los relajantes musculares sobre el músculo esquelético...

Láserterapia y láserpuntura. Alternativa de tratamiento en la pericoronaritis / Laser-therapy and laser-puncture. An alternative treatment in pericoronitis

La pericoronaritis es un proceso infeccioso agudo que aparece en las pacientes jóvenes, entre la segunda y tercera década de vida, por erupción de los terceros molares. Con el objetivo de demostrar la efectividad de la terapia láser en el tratamiento, se realizó un estudio longitudinal y prospectivo en una muestra de 80 pacientes que presentaron esta patología, los cuales asistieron al servicio de urgencia estomatológica del Policlínico Docente Universitario "Hermanos Cruz", en el período comprendido desde Enero 2009 a Febrero 2010. Para mejor estudio y aplicación del tratamiento se conformaron 2 grupos de 40 pacientes. Un primer grupo al que se le indicó antibioticoterapia, y además, se les aplicó una terapia láser de baja potencia con un equipo de fabricación cubana LASERMED 670 DL, el cual utiliza un diodo emisor de (Ga Al As) (670nm), se utilizó técnica puntual local, alrededor del capuchón dentario con parámetros analgésico y antinflamatorio (30mw, 36seg) y se aplicó láserpuntura. Un segundo grupo al cual se le aplicó la terapia convencional, utilizando antibioticoterapia y buchadas de peróxido de hidrógeno. El tratamiento con terapia láser resultó altamente efectivo, pues se reportó una remisión marcada de los síntomas, inflamación, dolor, y además, una disminución en el número de sesiones necesarias de tratamiento; se demostró estadísticamente con la prueba de ji cuadrado de independencia. Se comprueba la eficacia del tratamiento propuesto y se recomienda como opción terapéutica.

Pericoronitis is an acute infectious process that appears in young patients between the second and third decade of life during third molars eruption. The research was aimed at showing the effectiveness of laser-therapy through a longitudinal and prospective study that was conducted with a sample of 80 patients suffering from this pathology, these patients attended to the dentist emergency room at "Hermanos Cruz" Teaching Outpatient Clinic through January 2009-February 2010. To a better study and application of treatment two groups of 40 patients were comprised. The first group was treated with antibiotic and laser therapy of low-power using equipments made in Cuba (LASERMED 670-DL), which uses a transmission diode (Ga Al As) (670nm), local punctual technique was used around dental cap with analgesic parameters and anti-inflammatory (30mw, 36seg) and laser-puncture. The second group underwent conventional therapy with antibiotics and mouth washes of hydrogen peroxide. The treatment with laser was very effective observing a marked remission of symptoms, as well as inflammation, pain and a reduction in figures of necessary treatment sessions; which was statistically demonstrated by a chi-square test of independence. The effectiveness of treatment was confirmed, recommending it as a therapeutic alternative.

Efeitos dos recursos eletrofísicos na osteoporose: uma revisão da literatura / Effects of electrophysical resources in osteoporosis: a review of the literature

OBJETIVO: Fazer uma revisão bibliográfica a respeito dos efeitos dos principais recursos eletrofísicos utilizados na aceleração do metabolismo ósseo e no tratamento da osteoporose. ANTECEDENTES: A Organização Mundial da Saúde (OMS) define a osteoporose como doença esquelética sistêmica caracterizada por diminuição da massa óssea e deterioração microarquitetural do tecido ósseo, com consequente aumento da fragilidade óssea e susceptibilidade à fratura. Vários tratamentos medicamentosos e não medicamentosos vêm sendo desenvolvidos na tentativa de aumentar a massa óssea e prevenir a osteoporose. Dentro desse contexto, os recursos eletrofísicos vêm tendo um papel de destaque, como recursos que apresentam um potencial osteogênico, capazes de estimular a proliferação de osteoblastos e biomodular o metabolismo ósseo. ESTRATÉGIA DE PESQUISA: Foram consultadas as bases de dados: The Cochrane Library, MEDLINE, Embase, LILACS, SciELO, referências dos artigos identificados, e contato com especialisas em laser, entre os anos de 1983 e 2009. CRITÉRIOS DE SELEÇÃO: Foram incluídos estudos experimentais e ensaios clínicos randomizados que avaliaram os efeitos dos recursos eletrofísicos na osteoporose. RECOMPILAÇÃO E ANÁLISE DE DADOS: Dois revisores selecionaram independentemente os estudos, avaliaram sua qualidade metodológica dos estudos e coletaram os dados. RESULTADOS: Todos os recursos eletrofísicos citados neste artigo se mostraram eficazes na estimulação do metabolismo ósseo. No entanto, a grande maioria dos estudos realizados evidenciam esses efeitos através de estudos in vitro e estudos experimentais com cobaias. Cabe ressaltar que trabalhos como esses são raros em seres humanos. Baseado nos achados desta revisão pode ser sugerido que os recursos eletrofísicios como o laser terapêutico, o ultrassom, campos eletromagnéticos e plataformas vibratórias são recursos que tem um potencial osteogênico entretanto mais estudos são necessários para definir os efeitos dos mesmos em humanos, bem como, protocolos mais eficazes de tratamento. CONCLUSÃO: A partir deste levantamento bibliográfico, fica evidente que os recursos eletrofísicos apresentam um grande potencial osteogênico, porém, a maior parte dos estudos é in vitro. São necessários mais estudos in vivo, definindo, assim, melhores parâmetros e doses, para que sejam utilizados no tratamento da osteoporose.

OBJECTIVE: The aim of this article was to provide a literature review regarding the impact of the main eletrophysical resources used on the acceleration of bone metabolism and on the osteoporosis treatment. DEFINITION: The OMS defines osteoporosis as a Sistemic esqueletical disease characterized for diminished bone mass and for deterioration of the bone mass microarchitecture, increasing the bone fragility and susceptibility to fracture. Many drug or non-drug treatments are being developed as an attempt to increase the bone mass, and prevent osteoporosis. Within this context, the eletrophysical resources is having a prominence paper, as a resource which presents a osteogenic potencial, capable of stimulating the proliferation of osteoblasts and biomodulate the bone metabolism. RESEARCH STRATEGIES: The data base consulted were: The Cochrane Library, MEDLINE, Embase, LILACS, SciELO, references of indentified articles and contact with laser's especialists, between 1983 and 2009. SELECTION CRITERIA: Were included experimental study and randomized clinical tests on the effects of eletrophysical resources on osteoporosis. RECOMPILATION AND DATA ANALISIS: Two reviewers independently selected the studies, assessed their methodological quality and collected the data. RESULTS: All the eletrophysical resources quoted on this article were effective in stimulation of bone metabolism. However, most of the studies show these effects through in vitro studies and experimental studies with animals. It is important to say that experiments like these are rare in human beings. Based on the findings of this review, it may be suggested that the eletrophysical resources like lasertherapy, ultra-sound, electromagnetic fields and vibration are resources that has osteogenic potencial, but more studies are needed to define the effects of it in humans, as well as more effective treatment protocols. CONCLUSION: With this literature review it is clear that eletrophysical resources have high osteogenic potential, but most of the studies are in vitro. It is needed more studies in vivo, defining therefore, better parameters and doses to be used in the treatment of osteoporosis.

Laserterapia de baixa intensidade no tratamento de desordens temporomandibulares / Low level lasertherapy in treatment of temporomandibular disorders

As disfunções temporomandibulares (DTMs) compreendem alterações músculo-esqueléticas causadas por diversos fatores relacionados a aspectos físicos, psicológicos e sociais. Dentre os tratamentos existentes, o uso do laser de baixa intensidade tem sido promissor, proporcionando alívio imediato dos sintomas e possibilitando que o paciente retome suas atividades em um menor período de tempo. Neste contexto, em função de seus efeitos terapêuticos, a laserterapia tem se tornado uma modalidade bastante discutida. Portanto, a revisão literária deste estudo tem como objetivo apresentar o laser de baixa intensidade como uma alternativa física para o tratamento das DTMs, e também estimular a continuidade de pesquisas com esta terapia, para que a mesma possa ser bem empregada com resultados satisfatórios.

Temporomandibular disorders (TMDs) are musculoskeletal alterations caused by different factors related to physical, psychological and social aspects. Among the many methods of treatment, the use of Low Level Laser Therapy (LILT) is a very promising one, allowing an immediate pain relief, so that the patient can be able to return faster to a social contact. In this context, because of it’s therapeutic effects, the lasertherapy is becoming a widely dicussed way of treatment. The purpose of this literature review is to indicate the LILT as an important tool to treat temporomandibular disorders and also to stimulate other studies with this therapy, so that it can be properly used and achieve satisfactory results. At the end of this study, was suggested a protocol for those pacients that had been suffering of TMDs and who are seeking less aggressive a treatment that can allow an improvement of quality of life.